Illinois Medicaid to Docs: Starting 10/1, See Only Your Own Patients

In 2006, Illinois Medicaid began the Illinois Health Connect primary care case management (PCCM) program.  Illinois Health Connect assigns most Medicaid enrollees to a medical home, a primary care physician who is responsible for managing the patient’s care.  Several thousand people with HIV on Medicaid are enrolled in Illinois Health Connect.

Illinois Health Connect has been a strong success.  The Illinois Department of Healthcare and Family Services (HFS) estimates the program saved $100 million in FY 2008.

Beginning October 1 in Northwestern Illinois, all Illinois Health Connect patients will be required to see their own primary care provider for medical care.  A patient will need a referral to see any other primary care provider.  Providers will not be paid if they treat another providers’ patient without a referral (except in an emergency).

HFS says in a memo that it is implementing the referral requirement to improve care by strengthening the patient/provider relationship.   The referral requirement is established so “the patient’s Primary Care Provider (PCP) becomes familiar with [their patient’s] medical needs and ensures they receive the necessary preventive and primary care, including immunizations and screening, thus improving the quality of care for the patient through better coordination and management of services by the PCP.”

Note that patients may continue to see specialists, including HIV specialists, without a referral.

Referrals will be required in Cook County and Chicago beginning February 1, 2010.  The program will be implemented statewide by April 1, 2010.  HFS also provided a detailed roll-out schedule. 

If you have questions, contact the Illinois Health Connect hotline: 1-877-912-1999.

Additional information:
Illinois Health Connect
HFS provider notice (PDF)
Illinois Health Connect notice